Method and instrumentation for performing minimally invasive hip arthroplasty

ABSTRACT

A broaching instrument and method using a segmented broach head. First and second broach segments are laterally engageable with each other in vivo, and are aligned with each other on a common longitudinal axis when so engaged. The method involves making a small anterior incision adjacent a patient&#39;s femur, inserting the broach segments sequentially through the anterior incision, interconnecting the plurality of broach segments in vivo, connecting the broach handle to the broach segments, and broaching the proximal medullary canal with the assembled multi-part broach instrument.

CROSS REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Patent Application No. 60/534,270, filed Jan. 5, 2004, and U.S. patent application Ser. No. 10/912,644, filed Aug. 5, 2004, both of which applications are hereby incorporated by reference along with the following applications filed on Jan. 5, 2005: Attorney Docket No. 13007-24B entitled Method And Instrumentation For Performing Minimally Invasive Hip Arthroplasty and filed in the name of Troy W. Hershberger and Kimberly S. Parcher, and Attorney Docket No. 13007-24C entitled Method And Instrumentation For Performing Minimally Invasive Hip Arthroplasty and filed in the name of Troy W. Hershberger.

BACKGROUND OF THE INVENTION

This invention relates to methods and instruments for performing hip arthroplasty, and more particularly to broach instruments and methods for preparing the proximal femur to receive a femoral implant as part of an implantable hip prosthesis.

In one popular method of performing a total hip arthroplasty through two incisions, the femur is prepared by passing instrumentation through a small posterior lateral incision. This posterior incision is similar to the incision made when performing a conventional femoral intramedullary nailing procedure except that the incision is located somewhat more superior. A second, anterior incision is made to facilitate the introduction of instrumentation for preparation of the acetabulum as well as to expose the femur from the anterior side. The surgeon is able to view the femur and resect the femoral head from this anterior side. Access along the femoral axis for reamers and broaches is most readily accomplished, however, through the posterior lateral incision. The surgeon bluntly divides the fibers of the gluteus maximus through the posterior incision to develop a small tunnel through which he may pass the femoral broaches, reamers and, eventually, the femoral implant. The femur is broached through the posterior lateral incision while the femur is viewed through the anterior incision.

There are disadvantages associated with the prior method and instrumentation described above. These include the necessity of making the posterior lateral incision large enough to accommodate passage of the femoral broach and other instrumentation. Also, damage may be caused to the muscle fibers as well as the skin margins by excessive stretching of tissue and by repeatedly passing the broach and other instrumentation into and out of the posterior lateral incision.

SUMMARY OF THE INVENTION

According to one aspect of the present invention, a broach instrument for preparing the proximal medullary canal of a femur for receiving a hip stem implant comprises a segmented broach head which includes a first broach segment defining a longitudinal axis, and a second broach segment laterally engageable with the first broach segment in vivo, the second broach segment being aligned with the first broach segment on the longitudinal axis when engaged therewith.

Another aspect of the present invention is a novel method of preparing the proximal medullary canal of a patient's femur using a multi-part broaching instrument which includes a broach handle and a segmented broach head having a plurality of broach segments. The method comprises making a small anterior incision adjacent a patient's femur, inserting the broach segments sequentially through the anterior incision, interconnecting the plurality of broach segments in vivo, connecting the broach handle to the broach segments, and broaching the proximal medullary canal with the assembled multi-part broach instrument.

The objects and advantages of the present invention will be more apparent upon reading the following detailed description in conjunction with the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a side view of an assembled instrument according to one embodiment of the present invention.

FIG. 2 is an exploded side view of the instrument of FIG. 1

FIG. 3 illustrates placement and insertion of the parts of the instrument of FIG. 1 within a patient.

FIG. 4 is an exploded side view of another embodiment of the present invention.

FIG. 5 is a detail view, partially in cross section, of the embodiment of FIG. 4.

FIG. 6 is a side view of a further embodiment of the instrument of the present invention.

FIG. 7 is an exploded side view of the embodiment shown in FIG. 6.

FIG. 8 illustrates insertion and assembly of the parts of the instrument of FIG. 7 within a patient.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

For the purpose of promoting an understanding of the principles of the invention, reference will now be made to the embodiments illustrated in the drawings and specific language will be used to describe the same. It will nevertheless be understood that no limitation of the scope of the invention is thereby intended, such alterations and further modifications in the illustrated device and such further applications of the principles of the invention as illustrated therein being contemplated as would normally occur to one skilled in the art to which the invention relates.

It is desired to reduce the size of incisions necessary to perform a total hip arthroplasty in order to minimize trauma to the gluteus muscles and other underlying tissue adjacent the hip joint. According to the present invention, one approach to reducing the size of the incisions is to divide the broaching instrument used to broach the proximal medullary canal of the patient's femur into separate pieces, allowing the size of the incisions necessary to accommodate passage of the broach pieces to be reduced. The multi-piece broach instrument may include a laterally segmented broach head that may be inserted through the incisions and assembled within the patient, further reducing the size of the incisions necessary to accommodate passage of the broach segments into the patient.

In a first embodiment of the present invention, shown in FIG. 1, a multi-part broaching instrument 10 generally comprises a core shaft 12, a laterally divided or segmented broach head 14, and a broach handle 16. Core shaft 12, shown in FIG. 2, has a rigid shaft 18 terminating in a threaded distal end portion 20 and a proximal grip or knob 22. Broach handle 16 has an impact surface 24, an axial bore 26 for receiving the core shaft 12, a recess 28 for receiving the grip 22 and an anti-rotation key 30 for preventing the broach head 14 from rotating about the core shaft 12 during use.

The broach head 14 may be laterally divided or segmented into a plurality of broach segments as shown in FIG. 2. A distal broach segment 32 has a tip 34 sized and shaped to guide the instrument 10 into the femoral canal, a threaded aperture 36 for receiving the threaded end portion 20 of the core shaft 12, and a receiver slot 38 about the threaded aperture 36, shown as a dovetail type design. An intermediate broach segment 40 has an axial bore 42 therethrough positioned to align with the axial bore 26 of the broach handle 16 when assembled, a second receiver slot 44 about the axial bore 42 and a connector portion 46, shown as a dovetail type design, for insertion into the receiver slot 38 of the distal broach segment 32. A proximal broach segment 48 has an axial bore 50 therethrough positioned to align with the axial bores 42, 26 of the intermediate broach segment 40 and the broach handle 16 when assembled, and a second connector portion 52, also shown as a dovetail type design, for insertion into the second receiver slot of the intermediate broach segment. The broach segments and the handle may have a rectangular or curved cross-section, and the broach segments may be serrated partially or completely around the circumference thereof.

The instrument 10 is assembled during a total hip arthroplasty procedure as shown in FIG. 3. First, the broach segments 32, 40 and 48 are preferably inserted one at a time through the anterior incision 54 in the body of the patient 56. Segment 32 may be inserted first and positioned in the proximal medullary canal, then segment 40 may be inserted and laterally connected to segment 32, and then segment 48 may be inserted and laterally connected to segment 40. Alternatively, intermediate segment 40 may be inserted after segments 32 and 48 and connected therebetween. Next, the broach handle 16 is preferably inserted through the posterior incision 58 in the body of the patient 56. Next, the core shaft 12 is preferably advanced through the axial bores 26, 42 and 50 of the broach handle 16 and broach segments 40, 48. Finally, the core shaft 12 is rotated so that the threaded end portion 20 engages the threaded aperture 36 of the distal broach segment 32 so that the broach segments 32, 40 and 48 are drawn together against the broach handle 16. The core shaft restrains lateral movement of the broach segments to a degree by simple insertion therein, but its threaded tip is preferably screwed into broach segment 32 sufficiently to create a compression force which tightly secures the broach segments. Once assembled, the instrument 10 is manipulated through the posterior incision 58 of the patient 56 to broach the femoral canal 60 in preparation for receiving the hip stem implant.

When the broaching procedure is completed, the instrument 10 is preferably removed and disassembled in reverse order. First, the core shaft 12 is preferably rotated so that the threaded end portion 20 disengages the threaded aperture 36 of the distal broach segment 32 and is then removed from the broach segments 32, 40, 48 and broach handle 16. Next, the broach handle 16 is preferably removed from the posterior incision 58 of the patient 56. Finally, the broach segments 32, 40, 48 are then preferably removed from the patient 56 through the anterior incision 54 one at a time.

In another embodiment of the present invention, shown in FIGS. 4 and 5, a multi-part broaching instrument 110 employs a push-type design in which a core shaft 112 pushes against the distal broach segment 132 of a laterally segmented broach head 114, cooperating with the broach handle 116 to put the broach segments 132, 140 and 148 in tension. In this embodiment, the core shaft 112 may have an unthreaded distal tip 120 and the distal broach segment 132 may have an unthreaded mating aperture 136. Alternatively, the distal broach segment 132 may have no aperture other than the receiver slot in its dovetail joint. The broach segments 132, 140, 148 and the broach handle 116 are restrained longitudinally by their interconnected dovetail joints, and the core shaft 112, which is threaded into the broach handle 116, is used to create a tension force in the broach segments 132, 140, 148 by turning the knob 122 clockwise (for a right-handed thread as illustrated) to advance it toward the adjacent surface of the broach handle 116. The advancing distal tip 120 of the core shaft 112 engages the closed distal end of aperture 136 in the distal broach segment 132 and thus applies a distally directed force against that broach segment, thereby putting all the broach segments and the handle in tension.

A push-type design may alternatively be implemented with oppositely threaded portions on the two opposite ends of the core shaft. For example, instead of having an unthreaded distal tip, core shaft 112 may have left-hand threads on its distal end which act in opposition to the right-hand threads on its proximal end in the handle. That is, when rotated clockwise, the core shaft tends to back out of the distalmost broach segment and thereby further pushes on that segment as the threaded proximal end of the core shaft moves distally in the broach handle. The same core shaft may alternatively be used to put the broach segments in compression, by rotating the core shaft sufficiently in the counter-clockwise direction and thereby tending to draw the broach segments tightly together. In another alternative embodiment, the core shaft may have a hook-type end which engages the distalmost broach segment and pulls it toward the other broach segments as the core shaft is retracted in the broach handle. The broaching instrument is otherwise assembled and used in the same way as broaching instrument 10 previously described and illustrated.

In a further embodiment of the invention, shown in FIGS. 6-8, a multi-part broaching instrument 210 generally comprises a flexible core shaft 212, an offset broach handle 216 and, a laterally segmented broach head 214 as previously described and shown. Flexible core shaft 212 may be made of nitinol (NiTi) or wound cable terminating in a threaded end 220 and a tightening grip or knob 222. Offset broach handle 216 has an internal bore 226 for receiving core shaft 212, a recess 228 for receiving the tightening grip 222 and an anti-rotation key 230 for preventing the broach head 214 from rotating about core shaft 212 during use.

The instrument 210 is assembled during a total hip arthroplasty procedure as shown in FIG. 8. First, the broach segments 232, 240, 248 are preferably inserted one at a time through an anterior incision 254 made in the body of the patient 256 as previously described. Next, the offset broach handle 216 is then preferably inserted through the anterior incision 254 and positioned adjacent the broach head segments 232, 240, 248. Next, the flexible core shaft 212 is then preferably advanced through the internal bore 226 of the offset broach handle 216 and the axial bores 242, 250 of the broach head segments 240, 248. Finally, the core shaft 212 is rotated so that the threaded end 220 of the core shaft 212 is threadedly engaged with the threaded aperture 236 of the distal broach segment 232, creating a compression force that draws the broach segments 232, 240, 248 tightly against the offset broach handle 216. Once assembled, the instrument 210 is manipulated through the anterior incision 254 in the body of the patient 256 to broach the femoral canal 260 in preparation for receiving the hip stem implant.

When the broaching procedure is completed, the instrument 210 is preferably removed and disassembled in reverse order. First, the flexible core shaft 212 is preferably rotated so that the threaded end 220 disengages the threaded aperture 236 of the distal broach segment 232 and is then removed from the broach segments 232, 240, 248 and offset broach handle 216. Next, the offset broach handle 216 is preferably removed from the anterior incision 254 in the body of the patient 256.

While the invention has been illustrated and described in detail in the drawings and foregoing description, the same is to be considered as illustrative and not restrictive in character, it being understood that only the preferred embodiment has been shown and described and that all changes and modifications that come within the spirit of the invention are desired to be protected. For example, while a core shaft is described above as a preferred means for applying an axial force to the parts of the segmented broach head, alternative means are contemplated, such as a peripheral strap, a pair of peripheral straps, or other device extending alongside the broach segments, e.g., in a longitudinal groove therein, for creating a compression force. Rigid and semi-rigid rods and other peripheral devices are also contemplated in certain embodiments for creating tension in the broach segments. 

1. A broach instrument for preparing the proximal medullary canal of a femur for receiving a hip stem implant, comprising: a first broach segment defining a longitudinal axis; and a second broach segment laterally engageable with said first broach segment in vivo, said second broach segment being aligned with said first broach segment on said longitudinal axis when engaged therewith.
 2. The instrument of claim 1, further comprising auxiliary means for applying an axial force to said broach segments.
 3. The instrument of claim 2, wherein said broach segments each have a longitudinal bore therein, and wherein said means for applying an axial force includes a core shaft extending through said longitudinal bores.
 4. The instrument of claim 3, further comprising a broach handle having a bore therein for said core shaft, said core shaft being rotatably mounted in said broach handle.
 5. The instrument of claim 4, wherein said core shaft is axially restrained by said broach handle and has a threaded fastener portion on its distal end, and wherein the distalmost one of said broach segments includes a mating threaded fastener portion for engaging said core shaft and cooperating therewith to create a compression force on said broach segments when said core shaft is rotated in one direction.
 6. The instrument of claim 4, wherein said core shaft threadedly engages said broach handle and has an unthreaded distal end for engaging the distalmost one of said broach segments to create a tension force on said broach segments when said core shaft is rotated in one direction.
 7. The instrument of claim 4, wherein said broach handle has an offset portion with a bore extending therethrough for said core shaft, and wherein said core shaft is a flexible shaft.
 8. The instrument of claim 1, wherein said first and second broach segments include laterally engageable mating dovetail connectors.
 9. A method of preparing the proximal medullary canal of a patient's femur for receiving a hip stem implant, comprising: providing a multi-part broach instrument including a broach handle and a segmented broach head having a plurality of broach segments; making an anterior incision adjacent a patient's femur; inserting said broach segments sequentially through said anterior incision; interconnecting said plurality of broach segments in vivo; connecting said broach handle to said broach segments; and broaching said proximal medullary canal with the assembled multi-part broach instrument.
 10. The method of claim 9, wherein a compression force is applied to said interconnected broach segments with an auxiliary mechanism.
 11. The method of claim 10, wherein said auxiliary mechanism is a core shaft extending through a bore in said broach handle and a bore in each of said broach segments.
 12. The instrument of claim 11, wherein said core shaft is axially restrained by said broach handle and has a threaded fastener portion on its distal end, and wherein the distalmost one of said broach segments includes a mating threaded fastener portion for engaging said core shaft and cooperating therewith to create a compression force on said broach segments when said core shaft is rotated in one direction.
 13. The method of claim 9, wherein a tension force is applied to said interconnected broach segments with an auxiliary mechanism.
 14. The method of claim 13, wherein said auxiliary mechanism is a core shaft extending through a bore in said broach handle and a bore in each of said broach segments.
 15. The instrument of claim 14, wherein said core shaft threadedly engages said broach handle and has an unthreaded distal end for engaging the distalmost one of said broach segments to create a tension force on said broach segments when said core shaft is rotated in one direction.
 16. The instrument of claim 9, wherein said broach segments are laterally engageable segments.
 17. The instrument of claim 16, wherein said broach segments include mating dovetail connectors. 